Internal Medicine and Medical Investigation Journal

ISSN: 2474-7750

Acromioaxillosuprasternal Notch Index and Old Head and Anatomic Neck Criteria in Predict-ing Difficult Laryngoscopy in Tracheal Intubation in Children under General Anesthesia


Author(s): Nedasadat Mansouritehrani

Currently, various methods are being used for determining difficult

laryngoscopy. The present study aimed to compare the acromioaxillosuprasternal notch

index function with the old head and neck anatomic criteria in predicting difficult

laryngoscopy with respect to trachea intubation under general anesthesia in children.

Materials and Methods:

In this cross-sectional study, 379 children under intubation

with general anesthesia entered the study. Patients were divided into two groups: easy

laryngoscopy (grades 1 and 2) and difficult laryngoscopy (grades 3 and 4) based on

Cormack-Lehane score. The thyromental distance systems, height to thyromental

distance, Upper-Lip-Bite test, neck circumference, and acromioaxillosuprasternal

notch index were studied and compared.


Laryngoscopy was difficult in 48

subjects (38 were grade 3 and 10 were grade 4). Interestingly, no significant difference

was detected between easy and difficult laryngoscopies based on the thyromental

distance, neck circumference, height to thyromental distance, and acromioaxillosu-

prasternal notch index (P>0.05). height to thyromental distance , acromioaxillosu-

prasternal notch index , and neck circumference have a sensitivity of 32.2%, 47.9%,

51.1%, respectively, and the specificity was 52.7%, 45.6%, and 48.9%, respectively.


Neck circumference and acromioaxillosuprasternal notch index outper-

form the height to thyromental distance. On the other hand, Modified Mallampati test

is better than Upper-Lip-Bite test in determining difficult laryngoscopy in children.

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